Provider Demographics
NPI:1457051047
Name:HIMES, KHALIDA (LCSW)
Entity Type:Individual
Prefix:
First Name:KHALIDA
Middle Name:
Last Name:HIMES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 RIDGELAND AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2431
Mailing Address - Country:US
Mailing Address - Phone:630-618-8717
Mailing Address - Fax:
Practice Address - Street 1:2404 RIDGELAND AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2431
Practice Address - Country:US
Practice Address - Phone:630-618-8717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490247971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical